Indirect-comparison meta-analysis of treatment options for patients with refractory Kawasaki disease

BMC Pediatrics

Han Chan¹  Haiping Yang¹  Mo Wang¹  Qiu Li¹  Gaofu Zhang¹  Huan Chi²  Hui You² 

[1] 0000 0000 8653 0555, grid.203458.8, Department of Nephrology, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child Development and Critical, 400014, Chongqing, China;0000 0000 8653 0555, grid.203458.8, Graduate School of Chongqing Medical University, 400016, Chongqing, China;

关键词: Mucocutaneous lymph node syndrome;    Immunosuppressant;    Intravenous immunoglobulin;    Methylprednisolone;    Infliximab;    Second IVIG infusion;   

DOI  :  10.1186/s12887-019-1504-9

来源: publisher

【 摘 要 】

BackgroundThere is limited information available regarding the clinical management of intravenous immunoglobulin-resistant Kawasaki disease (KD). We aimed to evaluate the optimal treatment options for patients with refractory KD by presenting an indirect-comparison meta-analysis.MethodsPubMed, EMBASE, Web of Science, and the Cochrane Database were searched on August 31, 2018. Unpublished studies were also searched in ProQuest Dissertations & Theses and through manual retrieval strategies. Randomized concurrent controlled trials (RCTs), high-quality non-randomized concurrent controlled trials (non-RCTs), and retrospective studies associated with AEs were included. The quality of all eligible studies was assessed using Cochrane collaboration’s tool and non-randomized study guidelines. Risk ratios (RR) with 95% confidence intervals (CIs) for dichotomous outcomes were estimated in our analysis. GRADE profiler 3.6.1 was used to assess the evidence profile.ResultsTwelve studies involving 372 immunoglobulin-resistant KD patients were identified and analyzed. Neither infliximab nor intravenous pulse methylprednisolone (IVMP) was significantly more effective than second IVIG infusion with respect to lowering coronary artery lesions (CALs) (infliximab, 0.85, 0.43–1.69; IVMP, 0.99, 0.52–1.88) and treatment resistance (infliximab, 0.43, 0.21–0.89; IVMP, 1.16, 0.33–4.13). No significant differences were found between infliximab and IVMP in the incidence rate of CALs (0.70, 0.27–1.81), the treatment resistance (0.37, 0.09–1.60), the rates of coronary artery aneurysm (4.13, 0.38–45.22) and the coronary artery dilatation (0.45, 0.10–1.99). Furthermore, compared with second IVIG infusion, both infliximab and IVMP showed significant effectiveness in antipyretic effects (infliximab, 1.52, 1.16–1.99; IVMP, 1.29, 0.77–2.15). However, Infliximab was noninferior to IVMP on antipyretic effects (1.18, 0.66–2.15). IVMP treatment showed significant association with fewer AEs than second IVIG infusion (0.49, 0.26–0.94) and infliximab (2.34, 1.07–5.09). No significant differences were noted between infliximab treatment and second IVIG infusion (1.06, 0.69–1.63).ConclusionsInfliximab, IVMP, and second IVIG infusion showed no significant differences in the cardioprotective effect or the rate of treatment resistance. Infliximab and IVMP treatment were more effective than second IVIG infusion regarding antipyretic effects. IVMP treatment may have an advantage due to its lower total rate of AEs associated with drug infusion.Trial registrationThe study has been registered on PROSPERO (CRD42016039693).

【 授权许可】

CC BY